Dr Amitabh Gupta
If simple, every-day activities such as shaving, touching your face, eating, drinking, brushing your teeth, talking, putting on makeup, smiling, washing your face, etc. are causing pain in your face, jaw and nose, don’t ignore or take this pain lightly. Particularly if this pain is intense, stabbing, electric shock-like in nature, as it can be an underlying cause of some major complication in the head. The pain that typically involves the lower face and jaw, and sometimes the area around the nose and above the eye, is caused by irritation of the trigeminal nerve, a nerve that sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face. This chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain is called trigeminal neuralgia.
The largest of the cranial nerves, the trigeminal nerve is the fifth cranial nerve. It is responsible for sensation in the face and controls functions such as biting and chewing. One trigeminal nerve runs to the right side of the head, while the other runs to the left. Each of the two nerves has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). The ophthalmic and maxillary nerves are purely sensory, whereas the mandibular nerve supplies motor as well as sensory functions. After the trigeminal nerve leaves the brain and travels inside the skull, it divides into three smaller branches, controlling sensations throughout the face.
Causes of trigeminal neuralgia
It is a chronic pain condition that affects the trigeminal nerve. While it can occur at any age, it is most common in people over the age of 50. The National Institute of Neurological Disorders and Stroke, USA, notes that trigeminal neuralgia is more common in women than in men. Additionally, there is evidence that the disorder runs in families, likely as a result of an inherited blood vessel formation. Hypertension, multiple sclerosis, a tumour pressing on the trigeminal nerve, a brain lesion, surgical injuries, stroke or facial trauma are some of the causes.
Another most commonly reported cause of jaw pain is temporomandibular joint disorder (TMD). The condition affects up to 12 per cent of people. Nearly 5 per cent seek medical treatment due to the severity of the problem. Women of childbearing age are most commonly affected by TMD.
The pain can also be caused by lifestyle-related factors, including stress, sleep disturbances, lack of certain nutrients, or tiredness.
Simple strategies to reduce pain
Stress reduction: Try stress-relieving techniques to reduce jaw clenching like yoga, meditation, etc.
Avoid chewy foods: Foods that are chewy, tough, or crunchy can place a strain on the jaw joint and lead to pain and discomfort later.
Avoid caffeine: Avoiding large amounts of caffeinated coffee and tea may help reduce your jaw pain over time. However, you may initially feel muscle tension from caffeine withdrawal when cutting it out of your diet.
Most doctors will first recommend non-invasive treatment methods for the jaw pain. If the pain still persists, the doctor may recommend further interventions to find the cause of the pain.
The non-invasive treatments may include a wearing a mouth guard, especially at bedtime, to help stop you from unconsciously grinding your teeth, pain relievers and anti-inflammatory medicines or muscle relaxant drugs. The doctor may also recommend physical therapy, along with exercises to stretch and strengthen jaw muscles. Other treatments might include ultrasound, moist heat and ice.
If the pain still persists, apart from a thorough physical examination that includes assessment of the nerves, neck bones, jaw, mouth, and muscles, the specialist may recommend tests such as CT scan or MRI, psychological and psychiatric screening etc. In rare instances, a doctor may recommend surgery to correct trigeminal neuralgia or TMD problems. This is usually recommended for people with severe pain and pain that’s due to structural problems in the jaw joint.
Whatever the underlying causes of this pain, this should never be ignored.
— The writer is head of department, neurosurgery, Batra Hospital, New Delhi.
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